[LAPAROSCOPIC PARTIAL PERICYSTECTOMY OF SPLENIC HYDATID CYST - A CASE REPORT]. / LAPAROSKOPSKA PARCIJALNA PERICISTEKTOMIJA EHINOKOKNE CISTE SLEZENE - PRIKAZ BOLESNICE.

Echinococcal cyst of the spleen is usually a result of infection with the parasite Echinococcus granulosus. The spleen is the third most frequent localization of echinococcus after liver and lungs. Partial laparoscopic pericystectomy can be done without the loss of blood and scattering of scolexes with spleen preservation and conservation of its immune function. We present the patient with a large (1 8 x 16 x 12 cm) echinococcal cyst of the spleen that compressed the surrounding organs (stomach, transverse colon, pancreas and left kidney), and prevented normal passage causing vomiting after every meal. In this patient, PAIR procedure (puncture, aspiration, injection, reaspiration) and conservative treatment was attempted on several occasions without success. Finally, laparoscopic partial pericystectomy was performed, evacuating the contents of the cyst. The surgery lasted 120 minutes. Postoperatively the patient was without complications. Hospitalization lasted five days. Six months later, the patient is without problems. These echinococcus cysts of the spleen cannot be solved using PAIR technique and conservative treatment. Laparoscopic partial pericystectomy is a better solution than open surgery due to less trauma to the patient, especially in elderly people.

Laparoscopic surgery for large hydatide liver cyst after two previous laparotomies.

Laparoscopic surgery for hepatic echinococcosis is a technically difficult and demanding surgical procedure even for the most experienced abdominal surgeon. Surgery is performed after the conservative treatment with albendazole for 28 days. We report a case of laparoscopic partial pericystectomy with biliostasis and omentoplasty in a patient with two previously open surgeries (laparotomies)--right subcostal laparotomy for acute inflammation of the gallbladder and right pararectal laparotomy for perforated gangrenous appendix. The patient underwent extensive laparoscopic adhesiolysis due to pronounced intra-abdominal adhesions to gain access to a large hydatid cyst with the diameter of 11 cm. Laparoscopic surgery is much less traumatic to the patient with a better cosmetic effect.

Emergency surgery for large bowel obstruction caused by cancer.

There are several options for surgical treatment of large bowel obstruction caused by cancer, depending on location of obstruction, intraoperative local findings (perforation, peritonitis, bowel dilatation proximal to obstruction) and patients' condition. Resection and anastomosis as one stage surgery would be prefered procedure. Anastomotic leakage, on the other hand, highly elevates risk of mortality and mobidity. The most important question is whether to, in resectable cases, perform primary resection with anastomosis or not. This study was retrospective and included 40 patients that have undergone emergency surgery for large bowel obstruction caused by cancer. According to whether resection and anastomosis was made at initial surgery or not, patients were grouped in group A (N = 18) and group B (N = 21), respectively. We have analysed the type of surgical procedure, days of hospitalization, mortality, anastomotic leakeage, wound infection and other postoperative complications. Our results show that there is no major difference in mortality and morbidity in these two groups, suggesting that for selected patients primary resection and anastomosis is a safe option of tratment with acceptable risk. Since there are no strict guidelines or scorring system which would point the tratment option the decision about the choice of procedure still remains the burden of surgeon and depends on its experience and subspeciality. Our experience recomends primary resection and anastomosis except in cases of bowel perforation on tumor site, in cases of extreme dilatation and atony of bowel proximal to obstruction site and severe hypoproteinemia and anemia.

Quality of life after the Sweedish adjustable gastric band procedure.

The term "quality of life" usually describes factors that have an impact on living conditions within the society or on an individual. Generally, the term quality of life refers to the level of the welfare of individuals or group of people. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health and as such is one of the most common pathological conditions of modern society. Almost 10-25% of adult population in Europe, 1/3 population in the USA and 20% of population in Croatia are affected by obesity. In this prospective study we included 30 patients who underwent Sweedish adjustable gastric band procedure (SAGB) (Johnson & Johnson) procedures without complications during the first year of the postoperative period. Body mass index (BMI) was in female patients 40,52174 kg/m2 and in male patients 46,71429 kg/m2. Prior to the surgical procedures 13 patients (43.33%) experienced worse health conditions. Health conditions were equl in 17 patients. The treatment was ineffective in 5 patients (16.67%). In 5 patients health conditions were equal. 6 patients (20%) had good quality of life, 11 patients (36.67%) very good and only 3 patients (10%) had excellent quality of life after the procedure. We noticed body weight reduction in all patients. The quality of life was improved in all patients, except for one 28 years old woman. Body weight loss and quality of life after the procedure are in positive correlation which means that significant body weight loss leads to improved quality of life. Our conclusion is that SAGB is a quality method in obesity treatment which improves quality of life.

Mechanical bowel preparation in colorectal surgery.

The aim of this study was to assess the use of mechanical bowel preparation (MBP) and antimicrobial prophylaxis in elective colorectal surgery regarding still existing controversies. A prospective study of 85 patients undergoing elective colon and rectal surgery during 2 years period was performed, divided in two groups. Group A (N = 46) with patients who underwent mechanical bowel preparation, and group B (N = 39) patients without mechanical bowel preparation. We analysed: gender, age, preoperative difficulties, diagnostic colonoscopy, tumor localization, operation performed, pathohystological findings, Dukes classification, number of lymphonodes inspected, liver metastasis, other organ infiltrations, mean time of surgery, length of hospital stay, postoperative complications and mortality. Demographic characteristics, pathohystological findings, the site of malignancy, and type of surgical procedure did not significantly differentiate the two groups. The only significance revealed in mean time of surgery (138/178 minutes) in favor of patients with MBP (p = 0.017). Mechanical bowel preparation (MBP) for elective colorectal surgery is not advantageous. It does not influence radicalism of the procedure, does not decrease neither postoperative complications, nor hospital mortality.

Surgical treatment of liver echinococcosis--open or laparoscopic surgery?

Human echinococcosis remains a significant medical issue in endemic areas. Hydatid cysts can rupture, which is the most severe complication of echinococcosis as it can cause anaphylactic reaction and seeding of secondary cysts. Traditionally, hydatid cysts were evacuated by open surgical procedure in order to remove the entire cyst or by unroofing method, with evacuation of the cyst content. Recently, an increasing number of such operations are performed using laparoscopic approach. This study was prospectively conducted in a 5-year period, from 2004-2008. Altogether, 25 surgically treated patients were included in this study. Clinical examination, specific serological test, abdominal ultrasound and computed tomography were used for establishing diagnosis. Open surgery was initially performed in 17 patients and laparoscopic in 8. Three of those 8 patients required conversion to open surgery. Open pericystectomy was performed in 11 patients and laparoscopic pericystectomy in 3 patients. Open partial pericystectomy according to Papadimitriou was performed in 9 patients with hydatid cyst and laparoscopic partial pericistectomy in 2 patients. Our experience indicates that in the case of liver hydatid cyst disease, laparoscopic exploration, and if possible, laparoscopic pericystectomy or partial pericystectomy, should be performed in selected patients.

[Stercoral rectosigmoid colonic perforation with fecal peritonitis]. / Sterkoralna perforacija rektosigmoidnog kolona s fekalnim peritonitisom.

Chronic constipation can lead to fecal impaction and catastrophic complication such as colonic obstruction, perforation and fecal peritonitis. A case is reported of stercoral perforation of the rectosigmoid with pneumoperitoneum and fecal peritonitis. The patient was admitted for the signs of acute abdomen with pneumoperitoneum diagnosed on native radiological imaging.

[Laparoscopic versus open appendectomy: our experience and literature review]. / Laparoskopska ili otvorena apendektomija: nasa iskustva i pregled literature.

AIM: The controversy of the choice between open and laparoscopic appendectomy still remains. The benefits as well as disadvantages of laparoscopy are well known. METHODS: We designed a prospective 3-year clinical study (January 1, 2008-December 31,2010) with 123 patients operated on for acute appendicitis. They were prospectively divided into laparoscopic appendectomy (LA) group with 42 results and open appendectomy (OA) group with 81 results. The following parameters were analyzed: age, sex, preoperative leukocyte count, C-reactive protein (CRP) value, preoperative ultrasound finding (US), analgesic administration and histopathologic finding. The length of the operation, length of hospitalization (LOS) and complications were compared between the two groups, along with personal postoperative satisfaction estimated by telephone survey after discharge from the hospital. RESULTS: In 90% of cases, histopathology was positive for inflammation. CRP was determined in 42 (34%) patients preoperatively, with a mean value of 59; positive histopathology finding was recorded in 31 (74%) patients with increased preoperative CRP. US was performed in 68 (55%) patients; positive US was consistent with histopathology in 44 (65%) cases. The mean time of LA/ OA was 75/72 minutes. The only statistical difference was found for LOS: 4 versus 6 days (p < 0.01). CONCLUSION: LA and OA are comparable for the number of complications. The slight benefit of LA offers the surgeon free hand in decision when dealing with acute appendicitis needing urgent operation.

Laparoscopic synchronous resection of rectal cancer and liver metastases: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: During the past decade, there are several studies which showed the advantages of the laparoscopic approach for treating colorectal cancer (CRC) or colorectal cancer liver metastasis (CRCLM). However, in contrast, there are only a few reports of combined one stage synchronous laparoscopic colorectal and liver metastasis resection, cold one stage minimally invasive approach (MIA). CASE PRESENTATION: Our patient was 51 years old woman. Rectal adenocarcinoma was verified three centimeters from the anal verge. Magnetic resonance imaging (MRI) with rectal protocol modification indicated T1N0MO stage. We decided to do transanal local excision and achieved R0 resection. Half a year after the operation on the control MRI, lymphadenopathy was found along the rectum and possible recurrence of cancer. Also on the MRI was shown solitary, 4.7 × 2.7 × 3.8 cm big metastasis in the IVa/VIII segment of the liver. The patient was shown on a multidisciplinary team and it was decided to do laparoscopic synchronous resection of rectum and liver metastases. CLINICAL DISCUSSION: During the last decades many articles with different strategies for treating CRC and liver metastasis were published. Some of them prefered two-stage surgical treatment, like liver first approach which allows initial control of liver metastases, and delivery of preoperative radiotherapy for rectal cancer without the fear that liver metastases will meanwhile progress beyond the possibility of cure. Alternatively, the colon first approach is where the adjuvant chemotherapy is combined with the resection of the primary colorectal tumour with liver resection being undertaken (if at all) as a subsequent operation. By developing surgery, anaesthesia and critical care, the one stage approach for patients with CRC and liver metastasis started to be a reasonable option. CONCLUSION: Totally laparoscopic synchronous resection of the colorectal cancer and synchronous colorectal liver metastasis is technically feasible and safe in the hands of the experienced abdominal surgeon. This type of approach offers all the benefits of the laparoscopic minimally invasiveness associated with good oncological outcomes, and it is indicated in well-selected patients. However, the real scientific answer to this question can be given just with randomised control trial which will be a real challenge for endoscopic surgeons in the future.

Isolated splenic metastasis from colorectal carcinoma in a high risk patient: a case report.

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made.

Laparoscopic surgery of epidermoid cyst of the falciform ligament: A case report.

INTRODUCTION AND IMPORTANCE: The falciform ligament is a peritoneal fold that extends from the anterior abdominal wall to the liver, which divides the liver into two lobes. Cysts of the falciform ligament are rare and without an apparent cause. The range of the symptoms can vary from abdominal pain to asymptomatic patients. Cysts are treated surgically, and resection is used to make a definitive diagnosis. CASE PRESENTATION: A 36-year-old female patient was treated at an outpatient facility for epigastric pain that lasted for three months. Abdominal MRI and MSCT were performed to verify a cyst formation in the left liver area of about 12 cm in size. Laparoscopic resection of the cist was performed under general endotracheal anaesthesia. CLINICAL DISCUSSION: Falciform ligament tumours can be malignant or benign. Treatment of the cyst includes complete excision and pathohistological diagnosis to rule out malignancy. In most cases reported thus far, excision has been done after laparotomy. In our case, the operation was performed in a less invasive way, laparoscopically. CONCLUSION: Laparoscopy can serve as a diagnostic and therapeutic method for cysts of the falciform ligament, both smaller and more significant, that infiltrate the surrounding structures.

Laparoscopic repair of perforated peptic duodenal ulcer.

Although prevalence of peptic ulcer is decreasing, the number of peptic ulcer perforations appears to be unchanged. This complication of peptic ulcer is traditionally surgically treated. In recent years, a number of papers have been published where the authors managed perforated duodenal peptic ulcer in selected patients using laparoscopic approach. Laparoscopic treatment of perforated duodenal ulcer has been described as safe and advantageous compared to open technique but advantages are still not clear due to small number of cases in published studies. Based on these recommendations we decided to establish our own protocol for laparoscopic treatment of perforated peptic duodenal ulcer. In this prospective study we evaluated the first 10 patients in whom we performed laparoscopic repair of perforated duodenal ulcer. There were no conversions to open procedure and no early postoperative complications. The patients were contacted by phone a year after the operation, and all were satisfied with the operation and the appearance of postoperative scars. We regard laparoscopic repair of selected patients with perforated duodenal ulcer as a safe and preferable treatment.

Isolated splenic metastasis from colon cancer--case report and literature review.

Solitary splenic metastases are very rare and sporadic. There are several explanations for this low incidence of splenic metastasis including anatomical, histological and immunological features of the spleen. In this paper we present a case of 70-year-old man with no history of previous diseases who was first operated under the diagnosis of acute abdomen revealing perforated colon tumor of splenic flexure with no metastases at that time. Left hemicolectomy was performed followed by postoperative complications demanding a subtotal colectomy and ileostomy. Primary tumor was classified as Dukes (Astler-Coller)-C2, T4NIMO. Patient was referred to oncologist and received chemotherapy (5FU, Leucovorin). 5 months later continuity of the gut was performed by ileosygmoanastomosis. 2 years after first surgical procedure, a CT scan and abdominal ultrasound, followed by needle biopsy, showed isolated metastasis in spleen, so splenectomy was performed. Pathological findings revealed sharply bordered, partially necrotic tumor inside of spleen tissue, spreading to, but not reaching splenic hilum. Histology showed low to medium differentiated adenocarcinoma tissue with desmoplastic stromal reaction. There were no protrusions of tumor cells through spleen surface. In splenic hilum 4 tumor free lymph nodes were harvested. No additional chemotherapy was conducted. The latest follow up, a year after diagnosis of metastasis showed no signs of cancer disease. Review of the literature showed that long term survival and prognosis of isolated splenic colorectal metastasis after splenectomy are rather optimistic, although these are the cases of distant metastasis. Due to small number of cases reported in literature, definitive conclusions and/or guidelines for the treatment of isolated splenic metastasis cannot be given, but splenectomy and chemotherapy are preferable in the treatment, promising long term survival at least for metachronous metastasis.

[Laparoscopic diagnosis and desincarceration of inguinal Richter hernia: a case report]. / Laparoskopska dijagnoza i dezinkarceracija ingvinalne Richterove hernije-prikaz bolesnika.

In the cases of incarcerated Richter hernia the diagnosis is difficult especially for obese patients. Laparoscopic diagnostics and desincarceration, can be combined with mini laparotomy in lieu of bowel resection and open hernioplasty, or conversion to classic laparotomy and open hernioplasty. Here is presented a case of incarcerated Richter inguinal hernia managed through the combination of laparoscopy, mini laparotomy for segmental bowel resection and open hernioplasty.

[Laparoscopic partial pericystectomy of hepatic hydatid cysts --Papadimitriou operation: a case report]. / Laparoskopska parcijalna pericistektomija ehinokokne ciste jetre po papadimitriouu: prikaz bolesnika.

Operative treatment of hepatic hydatid cyst is technically demanding procedure. The method of choice is conservative treatment with Albendazolum followed by surgery. Open laparotomy or laparoscopic operation can be performed. We prefere laparoscopic exploration followed by laparoscopic total pericystectomy or laparoscopic partial pericystectomy. If laparoscopic operation is not possible due to technical reasons and patient safety, conversion to an open operation should be done, followed by total or partial pericystectomy. The case and our detailed technique of laparoscopic partial pericystectomy with biliostasis and omentoplasty is described. Laparoscopic operation is equally safe for the patient, yet with minor trauma and better aesthetic effect.

Pentadecapeptide BPC 157 resolves suprahepatic occlusion of the inferior caval vein, Budd-Chiari syndrome model in rats.

BACKGROUND: Recently, as a possible therapy resolving solution, pentadecapeptide BPC 157 therapy, has been used in alleviating various vascular occlusion disturbances. BPC 157 was previously reviewed as novel mediator of Robert cytoprotection and endothelium protection in the stomach, and gut-brain axis, beneficial therapy in gastrointestinal tract, with particular reference to vascular recruitment, ulcerative colitis and tumor cachexia, and other tissues healing. Here we raised new hypothesis about BPC 157 therapy in the Budd-Chiari syndrome in rats, rapid bypassing of the suprahepatic inferior caval vein occlusion, and rats recovery with the active and effective pharmacotherapy treatment. AIM: To investigate Budd-Chiari syndrome model (inferior caval vein suprahepatic occlusion) resolution, since BPC 157 resolves various rat vascular occlusion. METHODS: We assessed the activated bypassing pathways between the inferior and superior caval veins and portocaval shunt, counteracted caval/portal hypertension, aortal hypotension, venous/arterial thrombosis, electrocardiogram disturbances, liver and gastrointestinal lesions (i.e., stomach and duodenum hemorrhages, in particular, congestion). Rats with suprahepatic occlusion of the inferior vena cava by ligation were medicated at 1 min, 15 min, 24 h, or 48 h post-ligation. Medication consisted of 10 µg/kg BPC 157, 10 ng BPC 157 or 5 mL/kg saline, administered once as an abdominal bath or intragastric application. Gross and microscopic observations were made, in addition to assessments of electrical activity of the heart (electrocardiogram), portal and caval hypertension, aortal hypotension, thrombosis, hepatomegaly, splenomegaly and venography. Furthermore, levels of nitric oxide, malondialdehyde in the liver and serum enzymes were determined. RESULTS: BPC 157 counteracted increased P wave amplitude, tachycardia and ST-elevation, i.e., right heart failure from acute thrombotic coronary occlusion. The bypassing pathway of the inferior vena cava-azygos (hemiazygos) vein-superior vena cava and portocaval shunt occurred rapidly. Even with severe caval ˃ portal hypertension, BPC 157 antagonized portal and caval hypertension and aortal hypotension, and also reduced refractory ascites. Thrombosis of portal vein tributaries, inferior vena cava, and hepatic and coronary arteries was attenuated. In addition, there was reduced pathology of the lungs (severe capillary congestion) and liver (dilated central veins and terminal portal venules), decreased intestine hemorrhagic lesions (substantial capillary congestion, submucosal edema and architecture loss), and increased liver and spleen weight. During the period of ligation, nitric oxide- and malondialdehyde-levels in the liver remained within normal healthy values, and increases in serum enzymes were markedly reduced. CONCLUSION: BPC 157 counteracts Budd Chiari syndrome in rats.

Pentadecapeptide BPC 157 resolves Pringle maneuver in rats, both ischemia and reperfusion.

BACKGROUND: The Pringle maneuver [portal triad obstruction(PTO)] provides huge disturbances during ischemia and even more thereafter in reperfusion. Contrarily, a possible solution may be stable gastric pentadecapeptide BPC 157, with already documented beneficial effects in ischemia/reperfusion conditions. Recently, BPC 157, as a cytoprotective agent, successfully resolved vessel occlusions in rats (ischemic colitis; deep vein thrombosis, superior anterior pancreaticoduodenal vein; bile duct cirrhosis) through rapid collateral vessel recruitment to circumvent vessel occlusion. Thereby, medication BPC 157 regimens were administered as a single challenge before and during ischemia or, alternatively, at various time points during reperfusion. AIM: To introduce BPC 157 therapy against pringle maneuver-damage. METHODS: In deeply anesthetised rats, the portal triad was clamped up for 30 min. Rats then underwent reperfusion for either 15 min or 24 h. Medication [(10 µg, 10 ng/kg) regimens, administered as a single challenge] picked (a) ischemia, PTO period [at 5 min before (ip) or at 5 or 30 min of ligation time (as a bath to PTO)] or (b) reperfusion, post-PTO period [at 1 or 15 min (bath during surgery) or 24 h (ip) reperfusion-time]. We provided gross, microscopy, malondialdehyde, serum enzymes, electrocardiogram, portal, caval, and aortal pressure, thrombosis and venography assessments. RESULTS: BPC 157 counteracts electrocardiogram disturbances (increased P wave amplitude, S1Q3T3 QRS pattern and tachycardia). Rapidly presented vascular pathway (portal vein-superior mesenteric vein-inferior mesenteric vein-rectal veins-left ileal vein-inferior caval vein) as the adequate shunting immediately affected disturbed haemodynamics. Portal hypertension and severe aortal hypotension during PTO, as well as portal and caval hypertension and mild aortal hypotension in reperfusion and refractory ascites formation were markedly attenuated (during PTO) or completely abrogated (reperfusion); thrombosis in portal vein tributaries and inferior caval vein or hepatic artery was counteracted during portal triad obstruction PTO. Also, counteraction included the whole vicious injurious circle [i.e., lung pathology (severe capillary congestion), liver (dilated central veins and terminal portal venules), intestine (substantial capillary congestion, submucosal oedema, loss of villous architecture), splenomegaly, right heart (picked P wave values)] regularly perpetuated in ischemia and progressed by reperfusion in Pringle rats. CONCLUSION: BPC 157 resolves pringle maneuver-damage in rats, both for ischemia and reperfusion.

Laparoscopic operation of hepatic hydatid cyst with intraabdominal dissemination--a case report and literature review.

Hepatic hydatid cysts are a serious medical problem in some regions like Mediterranean region. In Croatia 25-30 new cases of hepatic hydatid cysts are recorded each year In University Hospital Dubrava 7 patients with hepatic hydatid cysts were operated in 2008. Surgical approach recognizes open laparotomy and laparoscopy. The case and technique of laparoscopic operation of hepatic hydatid cyst in seventh segment and three disseminated intraabdominal cysts is described. Laparoscopy should be attempted even in complex cases with dissemination.

Stable gastric pentadecapeptide BPC 157 in the treatment of colitis and ischemia and reperfusion in rats: New insights.

AIM: To provide new insights in treatment of colitis and ischemia and reperfusion in rats using stable gastric pentadecapeptide BPC 157. METHODS: Medication [BPC 157, L-NAME, L-arginine (alone/combined), saline] was bath at the blood deprived colon segment. During reperfusion, medication was BPC 157 or saline. We recorded (USB microscope camera) vessel presentation through next 15 min of ischemic colitis (IC-rats) or reperfusion (removed ligations) (IC + RL-rats); oxidative stress as MDA (increased (IC- and IC + RL-rats)) and NO levels (decreased (IC-rats); increased (IC + RL-rats)) in colon tissue. IC + OB-rats [IC-rats had additional colon obstruction (OB)] for 3 d (IC + OB-rats), then received BPC 157 bath. RESULTS: Commonly, in colon segment (25 mm, 2 ligations on left colic artery and vein, 3 arcade vessels within ligated segment), in IC-, IC + RL-, IC + OB-rats, BPC 157 (10 µg/kg) bath (1 mL/rat) increased vessel presentation, inside/outside arcade interconnections quickly reappeared, mucosal folds were preserved and the pale areas were small and markedly reduced. BPC 157 counteracted worsening effects induced by L-NAME (5 mg) and L-arginine (100 mg). MDA- and NO-levels were normal in BPC 157 treated IC-rats and IC + RL-rats. In addition, on day 10, BPC 157-treated IC + OB-rats presented almost completely spared mucosa with very small pale areas and no gross mucosal defects; the treated colon segment was of normal diameter, and only small adhesions were present. CONCLUSION: BPC 157 is a fundamental treatment that quickly restores blood supply to the ischemically injured area and rapidly activates collaterals. This effect involves the NO system.

Surgical treatment of mediastinal parathyroid adenoma.

Ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism after parathyroidectomy in patients with chronic renal failure on dialysis. An unusual anatomic localization of parathyroid adenoma may make the diagnosis and surgery difficult. In a 41-year-old woman with chronic renal failure, increased serum level of parathyroid hormone and symptoms of progressive renal osteodystrophy, mediastinal parathyroid adenoma was detected in the aorticopulmonary window by 99m Tc sesta MIBI scintigraphy and transmission computed tomography. Extirpation of adenoma, sized 3 x 2 cm, was performed through a left thoracotomy. Serum parathormone level returned to normal and the patient steadily recovered.